Name: ______________________________________________________________________________________________
Address: ____________________________________________________________________________________________
City, State, Zip: ___________________________________________________________________________________________
Phone Numbers: _____________________________________________________________________________________
Email Address: ______________________________________________________________________________________
Memberhsip Year runs from June 1 through May 31, of the following year.
_____ I am paying my 2009-2010 dues.
_____ I am paying my 2010-2011 dues.
Please check the level of membership you wish.
Student: $10 ________
Senior Citizen: $15 ________ (over 65)
Individual: $20 ________
Family: $30 ________
Sustaining: $60 ________
Patron: $150 ________
Life Membership: $500 ________
I am making a donation to the Philip A. Johnson Endowment Fund dedicated to the upkeep of the Museum of $_____________________.
I am making a donation to the General Fund for maintenance of the other properties, to offset activities costs, stock the gift shop, etc.
for the amount of $_____________________.
I am making a donation as a Memorial to: __________________________________________________ in the amount of $_____________________.
I have included the Leffingwell House Historic Museum (Society of the Founders of Norwich) in my will. _______
I am interested in including the Society of the Founders of Norwich in my will. ______
Annual dues are payable June 1 of each year. We appreciate it when you save us follow-up postage by mailing your dues promptly. Please make checks payable to: The Society of the Founders of Norwich, CT, Inc., and send to:
Mrs. Walter Green
c/o The Society of the Founders of Norwich, CT, Inc.
P.O. Box 13
Norwich, CT 06360-0013